Simplifying Medicare
We’ve created this guide to help you explore your Medicare options with confidence and clarity.
Our goal is to provide a local, trustworthy resource so you can make informed decisions about your coverage.
Medicare 101
Understanding Eligibility
The earliest you may begin your Medicare is on the first day of the month you turn 65. If you’re born on the first of the month, you’re eligible for the first of the preceding month.
For example, if you are turning 65 on May 17, 2026, then you can start Medicare on May 1, 2026. But if your 65th birthday is on May 1, 2026, then you can begin on April 1, 2026. You can skip enrolling in Medicare at 65 if you have other creditable coverage. When your creditable coverage ends, you’ll get a special enrollment period to join Medicare without any penalties.
If you’re receiving social security disability or have qualifying health conditions, you may be eligible much earlier.
Understanding Your Options
Original Medicare
Original Medicare is one of the main health coverage options available to you. It includes Part A (Hospital Insurance) and Part B (Medical Insurance), and you’ll automatically be enrolled in it unless you choose a Medicare Advantage plan or another Medicare-approved option.
With Original Medicare, you typically pay a share of the cost for covered services, such as deductibles and coinsurance. There’s no annual limit on out-of-pocket costs unless you have additional coverage, like a Medigap plan, Medicaid, or employer-sponsored insurance.
Part A - Hospital Insurance
Part A (Hospital Insurance) helps cover care you receive when you’re admitted to a facility or need specialized services. This includes inpatient hospital stays, skilled nursing facility care (short-term, not long-term or custodial care), hospice services, and certain home health care.
Part B - Medical Insurance
Part B helps cover medically necessary services and preventive care to keep you healthy. This includes doctor visits, outpatient care, certain home health services, durable medical equipment, mental health services, and some outpatient prescription drugs.
Part D - Prescription Drug Plans
Medicare Part D helps cover the cost of prescription medications and is available to anyone with Medicare. While enrollment is optional, it’s important to consider signing up when you’re first eligible, even if you don’t currently take medications.
If you delay enrolling and don’t have other creditable prescription drug coverage, you may have to pay a late enrollment penalty that gets added to your monthly premium for as long as you have Part D. To receive coverage, you must enroll in a Medicare-approved plan that includes prescription drug benefits.
Medigap - Medicare Supplement
Original Medicare doesn’t cover all your healthcare costs. Medicare Supplement Insurance (Medigap) plans, offered by private insurance companies, help pay for out-of-pocket expenses like copayments, coinsurance, and deductibles.
Some Medigap plans may also cover services that Original Medicare doesn’t, such as emergency medical care while traveling outside the U.S. However, Medigap plans generally do not cover long-term care, dental or vision services, hearing aids, eyeglasses, or private-duty nursing.
Medicare Advantage Plans
Medicare Advantage Plans are an alternative way to receive your Medicare Part A and Part B coverage. These plans are offered by private insurance companies approved by Medicare and must follow Medicare guidelines. You may also see them referred to as “Part C” or “MA Plans.”
Most Medicare Advantage Plans include prescription drug coverage (Part D) and may offer additional benefits beyond Original Medicare. These plans typically use provider networks, meaning you may need to see doctors and facilities within the plan’s network, though some services may be covered out of network at a higher cost.
Medicare Advantage Plans set an annual limit on your out-of-pocket costs for covered services, providing financial protection not available with Original Medicare alone. Depending on the plan, you may need referrals to see specialists or prior authorization for certain services or medications.
If you enroll in a Medicare Advantage Plan, you’ll still have Medicare, but your coverage will be provided through the plan rather than Original Medicare.
Dual Eligibles - Medicare and Medicaid
Individuals who are dual eligible qualify for both Medicare and full state Medicaid benefits. This combined coverage provides additional financial support, helping reduce or eliminate many out-of-pocket healthcare costs.
Medicare covers most standard medical services, while Medicaid may help pay for expenses like copays, coinsurance, deductibles, and premiums. Medicaid may also cover additional services not included in Medicare, such as long-term care, offering more comprehensive protection for your healthcare needs.